<!-- BEGIN debit_entry -->
{ITEMS_TABLE}
{COUPON_TABLE}

  <form action="{DEBIT_ENTRY_FORMACTION}" method="post">
	<p><table class="fullwidth">
	  <tr class="tbltitle">
		<td colspan="3">
		  <table class="fullwidth_invisible" cellspacing="0">
			<tr class="tbltitle">
			  <td width="10"><img src="{TYPE_IMG}" alt="{ALT_IMG}" title="{ALT_IMG}" border="0" vspace="0" align="left" /></td>
			  <td class="tbltitle" align="left">&nbsp;{TITLE}</td>
			</tr>
		  </table>
		</td>
	  </tr>
	  <tr>
		<td class="sub_option">{TXT_ACCOUNT_HOLDER}</td>
		<td class="option_value"><input type="text" name="account_holder" value="{ACCOUNT_HOLDER}" maxlength="25"></td>
	  </tr>
	  <tr>
		<td class="sub_option">{TXT_ACCOUNT_NUMBER}</td>
		<td class="option_value"><input type="text" name="account_number" value="{ACCOUNT_NUMBER}"size="17" maxlength="16"></td>
	  </tr>
	  <tr>
		<td class="sub_option">{TXT_BANK_CODE}</td>
		<td class="option_value"><input type="text" name="bank_code" value="{BANK_CODE}" size="9" maxlength="8"></td>
	  </tr>
	  <tr>
		<td class="sub_option">{TXT_TERMS_CONDITIONS}</td>
		<td class="option_value">
			<table cellspacing=0 cellpadding=0 border=0>
			<tr>
				<td valign=top><input type="checkbox" name="terms_conditions" value="1"{TERMS_CONDITIONS_1}></td>
				<td>&nbsp;</td>
				<td valign=top>{TXT_TERMS_CONDITIONS_READ} [<a href="{LINK_TERMS_CONDITIONS}" target="_blank">{TXT_TERMS_CONDITIONS_SHOW}</a>]</a></td>
			</tr>
			</table>
		</td>
	  </tr>
	  <tr>
		<td class="sub_option">{TXT_PASSWORD}</td>
		<td class="option_value">
			{TXT_CONFIRM_ORDER}<br>
			<input type="password" name="password" value="{PASSWORD}" maxlength="25">
		</td>
	  <tr class="tblfooter" >
		<td class="submit" colspan="3" >
<!--			<input class="submit" type="submit" name="cmd[cancel]" value="{CANCEL}" />//-->
			<input class="submit" type="submit" name="cmd[getDebitEntry]" value="{INPUT_VALUE}" />
		</td>
	  </tr>
	</table></p>
</form>
<!-- END debit_entry -->
<!-- BEGIN buyed_objects -->
<script language="JavaScript">
document.write('<p><a class="il_ContainerItemCommand" href="#" onClick="window.opener.location.href=\'{LINK_GOTO_BUYED_OBJECTS}\'; window.close(); return false">{TXT_GOTO_BUYED_OBJECTS}</a></p>');
</script>
<noscript>
<p><a class="il_ContainerItemCommand" href="{LINK_GOTO_BUYED_OBJECTS}">{TXT_GOTO_BUYED_OBJECTS}</a></p>
</noscript>
<!-- END buyed_objects -->
<script language="JavaScript">
document.write('<p><a class="il_ContainerItemCommand" href="javascript:window.close()">{TXT_CLOSE_WINDOW}</a></p>');
</script>
